Hawaii PRAMS Project Abstract The Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) program is a population-based surveillance system designed to identify and monitor maternal experiences, attitudes and behaviors from preconception through pregnancy and including the inter-conception period. PRAMS provides ongoing monitoring of maternal behaviors to determine how to reduce infant deaths, decrease low birth weights and improve the overall health of the population in Hawaii. The overall goal of the Hawaii PRAMS program is to reduce infant morbidity and mortality by impacting maternal and child health programs, policies, and maternal behaviors during pregnancy and early infancy. There are four PRAMS objectives to: 1) Collect high quality, population-based data on maternal behaviors before, during and after pregnancy and during the early life of the infant; 2) Conduct epidemiological analysis and study of maternal behaviors and experiences during pregnancy and early infancy and the relationship to health outcomes; 3) Translate data analyses into useable information for program planning, monitoring and evaluation; and 4) Increase public awareness of health pregnancy behaviors to improve maternal health across the life span. A PRAMS questionnaire is mailed to approximately 200 new mothers per month on all the major islands of Hawaii. The new mothers are identified by the Hawaii Department of Health (HDOH, Office of Health Status Monitoring) from the birth certificates of recently born infants. The Hawaii questionnaire includes questions asked by PRAMS programs in all states as well as standard questions selected for inclusion by the Hawaii PRAMS program in partnership with the Hawaii PRAMS Steering Committee, other HDOH program staff, and local healthcare providers. The questionnaire addresses priority maternal and infant health issues such as unintended pregnancies, contraception, smoking and alcohol use during pregnancy, insurance at the time of pregnancy, post-partum depression and domestic violence. Hawaii PRAMS standard questions address topics such as breastfeeding, dental care, drug use, general health, and maternal health conditions. Hawaii PRAMS data will be used to identify high risk populations and assist with directing resources, implementing effective interventions, and improving services to women, infants and their families. Data will help to address priority areas identified for Hawaii?s Title V Maternal and Child (MCH) Health Block Grant Needs Assessment (tied to state and national MCH priorities and Healthy People 2020 Objectives), including: 1) Reduce the rate of unintended pregnancy; 2) Increase abstinence from alcohol use during pregnancy; 3) Reduce smoking during the third trimester of pregnancy; 4) Promote breastfeeding; 5) Promote safe sleeping behaviors; 6) Promote utilization of oral health services during pregnancy, and 7) Promote Preconception/Interconception care.